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36
Small Pox.
An outbreak of this disease amongst the inmates of the institutions of the
St. Marylebone Guardians led to the detection and notification of 30 cases. The
following extracts from a special report to the Public Health Committee give the
main particulars with regard to the occurrence and the steps taken to deal with it.
All the cases were of the so-called " western type " of the disease, and there were
no deaths.
"The first case was seen on the night of Sunday, June 3rd, 1928, and since
that date 28 cases have been detected in the Home. In addition, and part of the
outbreak, there have been two detected by me at the St. Marylebone Hospital, and
one in a patient who, having been in the Home since May 18th, took his discharge
on the 30th May and spent the period between that date and 8th June, when he
was recognised to be suffering at Wandsworth, sleeping out at Epsom and elsewhere.
The source of his infection was probably the same as that of the cases
occurring at the Home between the 3rd June and 13th June, as well as of the two
cases at the Hospital.
"In spite of the fullest and most careful investigations this source has not
been found, though it was probably an individual (almost certainly a male inmate
since only one of the cases has come from the women's side) who spent some time
in the Home and had either taken his discharge before the search began or had
lost all signs of infection.
"The case of June 3rd when seen had been in an infective condition for at
least 5 days though the man had made no complaint with regard either to his
general condition or to the rash. Until the afternoon of the day of his detection,
he had been mixing freely not only with the inmates of the room he occupied but
with others. This absence of or extreme mildness of symptoms of onset has been
a curious feature of the outbreak and practically none of the patients has complained
at all and several might have escaped notice entirely had not regular
nightly inspections been carried out. Indeed the whole outbreak is probably due
to the fact that the original case or cases were so mildly attacked they either did
not find it necessary to report or were able to conceal the fact they were sick.
" In spite of the fact that the case of June 3rd had this start of at least 5
days of the precautions possible to be taken, in all it gave rise to only two others.
These in their turn, like all those that were detected after the first case, became
possible sources, but because of the precautions the chances in their favour grew
steadily less. This has in fact been shown in what has happened since the
campaign initiated since the occurrence of the outbreak and more particularly in
the later stages, each one of the patients notified having been individuals who had
not been re-vaccinated sufficiently early or had refused or evaded re-vaccination.
The patient detected on the 15th successfully avoided vaccination until June 10th,
the day before the onset of symptoms. In two other cases, one detected on the
26th, and the other on the 27th, there had been complete evasion.
"Prior to the appearance of the two last mentioned it had been proposed to
remove restrictions in respect of admissions and discharges completely on Monday
July 2nd. As a result of their occurrence it has been felt that certain limitations
must be imposed in spite of the difficulties that may be expected from a section of
the inmates who contend, rightly, that unless with their consent it is impossible
to refuse to allow them to take their discharge. After consultation with officers
of the Ministry of Health the course to be adopted is as follows: that on July 2nd
and thereafter all inmates who have been successfully vaccinated or re-vaccinated
within 16 days of the date of application shall be allowed to take discharge; that
unless they agree to vaccination, unvaccinated inmates shall be refused discharge
until restrictions are raised completely; that no person shall be admitted unless
they satisfy the medical officer that they have been successfully vaccinated or